European Journal of Pediatrics

, Volume 168, Issue 10, pp 1165–1169 | Cite as

Radioiodine treatment for pediatric hyperthyroid Grave’s disease

  • Ma Chao
  • Xie Jiawei
  • Wang Guoming
  • Liu Jianbin
  • Liu Wanxia
  • Al Driedger
  • Zuo Shuyao
  • Zhang Qin
Review
First Online:
Received:
Accepted:

Abstract

Grave’s disease (GD) is an autoimmune disease in which excessive amounts of thyroid hormones circulate in the blood. Treatment for pediatric GD includes (1) antithyroid drugs (ATD), (2) radioiodine, and (3) thyroidectomy. Yet, the optimal therapy remains controversial. We collected studies from all electronically available sources as well as from conferences held in China. All studies using radioiodine and/or ATD and/or thyroidectomy were included. Information was found on 1,874 pediatric GD patients treated with radioiodine, 1,279 patients treated with ATD and 1,362 patients treated surgically. The cure rate for radioiodine was 49.8%; the incidence of hypothyroidism, 37.8%; of relapse, 6.3%; of adverse effects, 1.55%; and of drop outs, 0.6%. These data show that radioiodine treatment is safe and effective in pediatric GD with significant lower incidence of relapse and adverse effects but significantly higher incidence of hypothyroidism as compared with both ATD and thyroidectomy. For the time being, radioiodine treatment for pediatric GD remains an excellent first-line therapy and a good second-line therapy for patients with ATD failure, severe complications, or poor compliance.

Keywords

Radioiodine therapy Thyrotoxicosis Surgery Graves’ disease Adolescents Antithyroid drug 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

We thank the Co-ordinator of the Metabolic and Endocrine Disorders Group and Dr. Bernd Richter, Gudrun Paletta, Susanne Ebrahim, contact editor, Dr. Wu Taixiang from Evidence based center West China Hospital are of invaluable help throughout the review and we are most grateful to them for their advice and support.

Conflicts of Interest

We stated that there are no financial or other relationships that might lead to a conflict of interest.

References

  1. 1.
    Amrhein JA, Kenny FM, Ross D (1970) Granulocytopenia, lupus-like syndrome, and other complications of propylthiouracil therapy. J Pediatr 76:54–63PubMedCrossRefGoogle Scholar
  2. 2.
    Bacon GE, Lowery GH (1965) Experience with surgical treatment of thyrotoxicosis in children. J Pediatr 67:1–5PubMedCrossRefGoogle Scholar
  3. 3.
    Bal C, Kumar A, Tripathi M et al (2005) High-dose radioiodine treatment for differentiated thyroid carcinoma is not associated with change in female fertility or any genetic risk to the offspring. Int J Radiat Oncol Biol Phys 63:449–455PubMedGoogle Scholar
  4. 4.
    Barnes HV, Blizzard RM (1977) Antithyroid drug therapy for toxic diffuse goiter (Graves disease): thirty years experience in children and adolescents. J Pediatr 91:313–320PubMedCrossRefGoogle Scholar
  5. 5.
    Barrio R, Lopez-Capape M, Martinez-Badas I et al (2005) Graves’ disease in children and adolescents: response to long-term treatment. Acta Paediatr 94:1583–1589PubMedCrossRefGoogle Scholar
  6. 6.
    Becker DV, Hurley JR (1971) Complications of radioiodine treatment of hyperthyroidism. Semin Nucl Med 1:442–460PubMedGoogle Scholar
  7. 7.
    Bergman P, Auldist AW, Cameron F (2001) Review of the outcome of management of Graves’ disease in children and adolescents. J Paediatr Child Health 37:176–182PubMedCrossRefGoogle Scholar
  8. 8.
    Bhadada S, Bhansali A, Velayutham P et al (2006) Juvenile hyperthyroidism: an experience. Indian Pediatr 43:301–307PubMedGoogle Scholar
  9. 9.
    Buckingham BA, Costin G, Roe TF et al (1981) Hyperthyroidism in children. A reevaluation of treatment. Am J Dis Child 135:112–117PubMedGoogle Scholar
  10. 10.
    Cheetham T, Wraight P, Hughes IA et al (1998) Radioiodine treatment of Graves’ disease in young people. Horm Res 49:258–262PubMedCrossRefGoogle Scholar
  11. 11.
    Chen XH, Shen ZG, Zheng GQ et al (2000) The surgical treatment of hyperthyroidism in patients aged under 18 years. Chinese Journal of General Surgery 9:527–529Google Scholar
  12. 12.
    Chen DY, Chen TH (2005) Comparison of efficacy of 131I and antithyroid drugs in the treatment of Graves’ disease in children. Chin J Pediatr 143:507–509Google Scholar
  13. 13.
    Chen HH, Liao N (2007) The analysis of therapeutic effects of radioiodine for Grave’s disease in children. Chinese Journal of Misdiagnostics 7:2577–2578Google Scholar
  14. 14.
    Clark JD, Gelfand MJ, Elgazzar AH (1995) Iodine-131 therapy of hyperthyroidism in pediatric patients. J Nucl Med 36:442–445PubMedGoogle Scholar
  15. 15.
    Crile G Jr, Schumacher OP (1965) Radioactive iodine treatment of Graves’ disease. Results in 32 children under 16 years of age. Am J Dis Child 110:501–504PubMedGoogle Scholar
  16. 16.
    Deng B, Xiao H, Chen HM et al (2006) The analysis of therapeutic effects of radioiodine treatment for pediatric patients with Grave’s disease and incidence of hypothyroidism. Journal of Chinese Physician 18:1136–1137Google Scholar
  17. 17.
    Dotsch J, Siebler T, Hauffa BP et al (2000) Diagnosis and management of juvenile hyperthyroidism in Germany: a retrospective multicenter study. J Pediatr Endocrinol Metab 13:879–885PubMedGoogle Scholar
  18. 18.
    Dou ZX, Wang J, Wang GY et al (2004) Effect of bilateral subotal thyroidectomy for juvenile hyperthyroidism. Journal of Applied Clinical Pediatrics 19:146–147Google Scholar
  19. 19.
    Fisher DA (1994) Graves’ disease in children. Curr Ther Endocrinol Metab 5:71–74PubMedGoogle Scholar
  20. 20.
    Freitas JE, Swanson DP, Gross MD et al (1979) Iodine-131: optimal therapy for hyperthyroidism in children and adolescents? J Nucl Med 20:847–850PubMedGoogle Scholar
  21. 21.
    Goldsmith RE (1972) Radioisotope therapy for Graves’ disease. Mayo Clin Proc 47:953–961PubMedGoogle Scholar
  22. 22.
    Gruneiro-Papendieck L, Chiesa A, Finkielstain G et al (2003) Pediatric Graves’ disease: outcome and treatment. J Pediatr Endocrinol Metab 16:1249–1255PubMedGoogle Scholar
  23. 23.
    Hamburger JI (1985) Management of hyperthyroidism in children and adolescents. J Clin Endocrinol Metab 60:1019–1024PubMedCrossRefGoogle Scholar
  24. 24.
    Hawkins MM, Draper GJ, Smith RA (1989) Cancer among 1348 offspring of survivors of childhood cancer. Int J Cancer 43:975–978PubMedCrossRefGoogle Scholar
  25. 25.
    Hawkins MM (1991) Is there evidence of a therapy related increase in germ cell mutation among childhood cancer survivors? J Natl Cancer Inst 83:1643–1650PubMedCrossRefGoogle Scholar
  26. 26.
    Hayek A, Chapman EM, Crawford JD (1970) Long-term results of treatment of thyrotoxicosis in children and adolescents with radioactive iodine. N Engl J Med 29;283:949–953Google Scholar
  27. 27.
    Hayles AB, Kennedy RL, Beahrs OH et al (1959) Exophthalmic goiter in children. J Clin Endocrinol Metab 19:138–151PubMedCrossRefGoogle Scholar
  28. 28.
    Hu B, Wei YF, Huang C et al (2006) The strategy and relevant problems of radioiodine treatment for pediatric Grave’s disease. Journal of Medical Forum 27:67–68Google Scholar
  29. 29.
    Huang BH, Zhen ZW, Chen CL et al (2006) The analysis of therapeutic effects of radioiodine treatment for pediatric patients with Grave’s disease. China Tropical Medicine 6:634–635Google Scholar
  30. 30.
    Jiang X, Chen S (2005) The surgery treatment of pediatric hyperthroidism. Hainan Medical Journal 14:26–27Google Scholar
  31. 31.
    Kogut MD, Kaplan SA, Collip PJ et al (1965) Treatment of hyperthyroidism in children. N Engl J Med 272:217–221PubMedCrossRefGoogle Scholar
  32. 32.
    Lazar L, Kalter-Leibovici O, Pertzelan A et al (2000) Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients. J Clin Endocrinol Metab 85:3678–3682PubMedCrossRefGoogle Scholar
  33. 33.
    Lao DH, Xh Ye (2006) The analysis of treatments for pediatric Grave’s disease. Guangxi Medical Journal 28:1785–1786Google Scholar
  34. 34.
    Leu SW, Chi CS, Shu SG (2003) Outcome of antithyroid medication and radioiodine therapy in pediatric Graves’ disease. Acta Paediatr Taiwan 44:220–226PubMedGoogle Scholar
  35. 35.
    Ldfranchi S, Mandel SH (1995) Garve’ disease in the neonatal period and childhood. In: Braverman LE, Utiger RD (eds) Clinical text. Lippincott, Philidelphia, pp 1237–1246Google Scholar
  36. 36.
    Lippe BM, Landaw EM, Kaplan SA (1987) Hyperthyroidism in children treated with long term medical therapy: twenty-five percent remission every two years. J Clin Endocrinol Metab 64:1241–1245PubMedCrossRefGoogle Scholar
  37. 37.
    Liu YF, Tan DD, Liu HF (2003) The report of surgical treatment for pediatric Grave’s disease. Chinese Medical Journal 3:43–44Google Scholar
  38. 38.
    Liu ZC, Liu DM, Liu DY et al (2005) The report of surgical treatment for pediatric Grave’s disease. Central Plains Medical Journal 33:56Google Scholar
  39. 39.
    Maenpaa J, Kuusi A (1980) Childhood hyperthyroidism. Results of treatment. Acta Paediatr Scand 69:137–142PubMedCrossRefGoogle Scholar
  40. 40.
    Moll GW Jr, Patel BR (1997) Pediatric Graves’ disease: therapeutic options and experience with radioiodine at the University of Mississippi Medical Center. South Med J 90:1017–1022PubMedCrossRefGoogle Scholar
  41. 41.
    Mulvihill JJ, Myers MH, Connelly RR et al (1987) Cancer in offsprings of long-term survivors of childhood and adolescent cancer. Lancet 2:813–817PubMedCrossRefGoogle Scholar
  42. 42.
    Nebesio TD, Siddiqui AR, Pescovitz OH et al (2002) Time course to hypothyroidism after fixed-dose radioablation therapy of Graves’ Disease in children. J Pediatr 141:99–103PubMedCrossRefGoogle Scholar
  43. 43.
    Otake M, Schull WJ, Neel JV (1990) Congenital malformations, stillbirths and early mortality among the children of atomic bomb survivors: a reanalysis. Radiat Res 122:1–11PubMedCrossRefGoogle Scholar
  44. 44.
    Qin L, Wang JQ, Fenf XM et al (2004) Efficacy of (131) I therapy hyperthyroidism in adolescent. Journal of Isotopes 17:186–190Google Scholar
  45. 45.
    Read CH Jr, Tansey MJ, Menda Y (2004) A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves’ patients. J Clin Endocrinol Metab 89:4229–4233PubMedCrossRefGoogle Scholar
  46. 46.
    Reid JR, Wheeler SF (2005) Hyperthyroidism: diagnosis and treatment. Am Fam Physician 72:623–630PubMedGoogle Scholar
  47. 47.
    Rivkees SA (1998) Clinical review 99: the management of Graves’ disease in children, with special emphasis on radioiodine treatment. J Clin Endocrinol Metab 83:3767–3776PubMedCrossRefGoogle Scholar
  48. 48.
    Robinson A, Linden MG (1993) Three to 5% of all births result in congenital malformations. In: Clinical genetic handbook. Blackwell, BostonGoogle Scholar
  49. 49.
    Rudberg C, Johansson H, Akerstrom G et al (1996) Graves’ disease in children and adolescents. Late results of surgical treatment. Eur J Endocrinol 134:710–715PubMedCrossRefGoogle Scholar
  50. 50.
    Safa AM, Schumacher OP, Rodriguez-Antunez A (1975) Long-term follow-up results in children and adolescents treated with radioactive iodine (131I) for hyperthyroidism. N Engl J Med 292:167–171PubMedGoogle Scholar
  51. 51.
    Saxena KM, Crawford JD, Talbot NB (1964) Childhood thyrotoxicosis: a long term perspective. Br Med J 2:1153–1158PubMedCrossRefGoogle Scholar
  52. 52.
    Schull WJ, Otake M, Neel JV (1981) Genetic effects of atomic bombs: a re-appraisal. Science 213:1220–1227PubMedCrossRefGoogle Scholar
  53. 53.
    Sheline GE, Lindsay S, McCormack KR et al (1962) Thyroid nodules occurring late after treatment of thyrotoxicosis with radioiodine. J Clin Endocrinol Metab 22:8–18PubMedCrossRefGoogle Scholar
  54. 54.
    Soreide JA, van Heerden JA, Lo CY et al (1996) Surgical treatment of Graves’ disease in patients younger than 18 years. World J Surg 20:794–800PubMedCrossRefGoogle Scholar
  55. 55.
    Starr P, Jaffe HL, Oettinger L Jr (1969) Later results of 131-I treatment of hyperthyroidism in 73 children and adolescents: 1967 follow up. J Nucl Med 10:586–590PubMedGoogle Scholar
  56. 56.
    Sugino K, Ito K, Mimura T et al (2004) Surgical treatment of Graves’ disease in children. Thyroid 14:447–452PubMedCrossRefGoogle Scholar
  57. 57.
    Vaidya VA, Bongiovanni AM, Parks JS et al (1974) Twenty-two years' experience in the medical management of juvenile thyrotoxicosis. Pediatrics 54:565–570PubMedGoogle Scholar
  58. 58.
    Walter MA, Briel M, Christ-Crain M et al (2007) Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials treatment: systematic review and meta-analysis. BMJ 334:514PubMedCrossRefGoogle Scholar
  59. 59.
    Wang Q, Yang JS (2003) Clinical study of 128 adolescent hyperthyroidism after (131) I therapy. Chinese Journal of Coal Industry Medicine 6:581Google Scholar
  60. 60.
    Ward L, Huot C, Lambert R et al (1999) Outcome of pediatric Graves’ disease after treatment with antithyroid medication and radioiodine. Clin Invest Med 22:132–139PubMedGoogle Scholar
  61. 61.
    Wei XJ (1999) Experience with surgical treatment for juvenile hyperthyroidism. Journal of Youjiang Medical College for Nationalities 2:199–200Google Scholar
  62. 62.
    Wei XZ, Lin ZX (2001) Surgical treatment of juvenile hyperthyroidism. Chinese Journal of General Surgery 16:168–169Google Scholar
  63. 63.
    Wu WQ (2001) Effect of surgical treatment for juvenile hyperthyroidism. Guangxi Medical Journal 23:910–911Google Scholar
  64. 64.
    Xia LH, Zeng FZ, Chen BH et al (2003) The experience of thyroidectomy on children hypothyroidism. Modern Medicine Health 19:704Google Scholar
  65. 65.
    Xue JJ, Yang AM, Wang Y et al (2006) Radioiodine treatment for pediatric Grave’s disease. Journal of Chinese Physician 8:136–136Google Scholar
  66. 66.
    Yoshimoto Y, Neel JV, Schull WJ et al (1990) Malignant tumors during the first two decades of life in the offsprings of atomic bomb survivors. Am J Hum Genet 46:1041–1052PubMedGoogle Scholar
  67. 67.
    Zhao ZJ, Cheng TG, Yan JF (2003) The therapeutic effects of surgery for children hyperthyroidism. Chinese New Medicine 4:516–517Google Scholar
  68. 68.
    Zhong ZQ, Zeng FZ (1999) Effect of thyroidectomy for juvenile hyperthyroidism. Guangdong Medical Journal 20:155–156Google Scholar
  69. 69.
    Zhou WS (2005) Clinical study of 278 adolescent hyperthyroidism after (131) I therapy. Hainan Medical Journal 16:51Google Scholar
  70. 70.
    Zhou KQ (2005) The investigation of surgery for children hyperthyroidism. Henan Journal of Surgery 11:37Google Scholar
  71. 71.
    Zimmerman D, Lteif AN (1998) Thyrotoxicosis in children. Endocrinol Metab Clin North Am 27:109–126PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ma Chao
    • 1
  • Xie Jiawei
    • 2
  • Wang Guoming
    • 1
  • Liu Jianbin
    • 3
  • Liu Wanxia
    • 3
  • Al Driedger
    • 4
  • Zuo Shuyao
    • 1
  • Zhang Qin
    • 1
  1. 1.Department of Nuclear Medicine Affiliated HospitalQingdao UniversityQingdaoChina
  2. 2.Medical School of Qingdao UniversityQingdaoChina
  3. 3.Department of Nuclear MedicineQingdao Municipal HospitalQingdaoChina
  4. 4.Department of Nuclear Medicine/OncologyUniversity of Western OntarioLondonCanada

Personalised recommendations